Title : Through a skewed and sealed window an unplanned IOL exchange a sequel to pediatric cataract surgery
Abstract:
The coexistence of ectopic pupil and microcoria is a rare and, to our knowledge, previously unreported postoperative sequelae of primary congenital cataract surgery. A 5-year-old boy who was operated elsewhere for congenital cataract at 1 year of age presented to us with an ectopic micro pupil and peripheral anterior synechiae. Refraction and fundus examination was not possible as the pupil was non dilating to any mydriatic. Hence, a pupilloplasty procedure was planned after Bscan ultrasound was found to be normal. The pupil was expanded using iris hooks after synechiolysis using microscissors. Though the visual axis was clear, a single piece foldable IOL was found decentered and malpositioned with one haptic in sulcus and another behind the posterior capsule. Due to risk of glaucoma and progressive dislocation, the IOL was explanted through a small sclerocorneal tunnel and a multipiece Acrylic foldable IOL was placed in the sulcus. Postoperatively vision improved from 1/60 to 6/60 (Snellen).
